臺灣博碩士論文加值系統

摘要
背景
中風會帶給家庭與社會的重大負擔，如何增進復健治療的效率與減輕照護系統的負荷一直是重要的議題。我國急性後期照護計畫每三周評估功能指標，透過探討功能指標變化之相關因素以增進出院準備的效率是本篇研究的背景與動機。
目標
分析急性後期照護計畫之中風患者其功能指標的恢復趨勢。
分析急性後期照護計畫之中風患者其功能指標變化之相關因素。
方法
研究利用固定世代追蹤研究以對216位急性後期照護計畫內中風患者，分析其功能指標的恢復趨勢與相關影響因素。研究自變項包括: 年齡、性別、患側、住院時間與中風類型。爾後透過廣義估計方程式分析功能指標在不同因素下的恢復趨勢，功能指標包括伯格氏平衡量表、行走速度、六分鐘行走測試。
結果
廣義估計方程式顯示隨著追蹤時間增加，功能指標的恢復趨勢也正向增加。
廣義估計方程式顯示在損傷種類上，出血性中風在六分鐘行走測試上恢復趨勢上比其他類型為差，而其他類型中風在伯格氏平衡量表上恢復趨勢比梗塞性或出血性中風較佳。此外，少於65歲的組別在行走速度上也有較佳的恢復趨勢。最後透過變異數分析，初評伯格氏平衡量表分數在三周出院的患者上得分較高，具有顯著差異。
結論
結果上，年齡在平衡與心肺耐力上，趨勢較佳，損傷種類上，出血型心肺能力趨勢較差，其他(小洞中風等)平衡能力趨勢較佳，初評上，伯格氏平衡量表分數在三周出院的患者上得分較高。綜合以上，年齡、損傷種類可做為中風病人觀察功能趨勢的變化因素，而損傷側與性別無差異存在，伯格氏平衡量表推薦可作為出院時間的參考。
研究結果可作為臨床人員可依據以上分析結果加強訓練以及與患者家庭溝通。以使患者與家庭了解可能的恢復趨勢與出院時間。作為出院準備與社區適應的知識。經過我們的研究，我們驗證了不同的患者因素的確有不同的趨勢，以及不同的初評結果會有不同的留院時間。

Abstract
Background
Stroke is the main cause of death and disability in the global population. In recent years, stroke has been the top ten causes of death in Taiwan, and there is also a trend of the younger onset. The current study is aimed to improve the efficiency of intervention and reduce the burden of families. The post-acute care in Taiwan was developed to solve those needs. In PAC program we evaluated functional indicators every 3weeks, and we proposed to use those functional indicators to communicate with patients and their caregivers about the recover trends to have better discharge plans.
Objectives
To analyze the trend and associated factors for functional developments of stroke patients in PAC program. The measurement of functional development included three indicators: six-minute walking test (6MWT), usual gait speed (UGS), and Berg's balance scale (BBS).
Methods
This fixed cohort study recruited a total of 216 patients in the PAC program. The study independent variables were age, gender, lesion type, lesion side, initial evaluation, and length of stay. The Generalized estimating equation (GEE) was applied to analyze the changes and associated factors for the functional development of evaluation indicators.
Results
The GEE results displayed the significant time trend of improvement for BBS, 6MWT, and UGS. The stroke type of hemorrhage had significant impact on the recovery of 6MWT and the younger age had significant recovery trends of UGS. Besides, our results demonstrate the higher BBS initial scores significantly resulted in 3 weeks performance.

Conclusion
In summary, age and lesion type can be used as a change factor in the trend of functional evaluation of stroke patients, and there is no difference between the lesion side and gender. The Berg's balance scale is recommended as a reference for discharge time.

目錄
序言 II
摘要 III
Abstract V
圖目錄 IX
表目錄 X
CHAPTER I. Introduction 1
1- 1 Background 1
1.2 Study Purpose 3
1.3 Significance of the study 4
CHAPTER II. Literature Review 5
CHAPTER III. Methods 17
3.1 Conceptual Framework 17
3.2Data Sources 20
3.3 Study Variables 22
3.4. Analytical Methods 24
CHAPTER IV. Results 25
CHAPTER V. Discussion 47
CHAPTER VI. Conclusion 51
References 54
Appendices 62


圖目錄
Figure 1 16
Figure 2 17
Figure 3 20
Figure 4 44
Figure 5 45
Figure 6 46

表目錄
Table 1 Distribution of variables 26
Table 2 Mean of BBS by groups 28
Table 3 BBS recovery trend by groups 29
Table 4 Mean of UGS by groups 31
Table 5 UGS recovery trend by groups 32
Table 6 Mean of 6MWT by groups 35
Table 7 6MWT recovery trend by groups 36
Table 8 Descriptive statistics of functional indexes in different length of stay 38
Table 9 ANOVA of functional indexes 39
Table 10 Post hoc of functional indexes 40
Table 11 multiple comparism of BBS in different length of stay 41
Table 12 multiple comparism of UGS in different length of stay 42
Table 13 multiple comparism of 6MWT in different length of stay 43

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